Figure 1 depicts the natural history of chronic HBV infection. The immune-tolerance phase is seen in HBeAg-positive disease and is characterised by high levels of HBV replication with normal ALT levels and limited liver necroinflammation. Because there is minimal immune response to the virus it is unusual for spontaneous HBeAg loss to occur. This phase is commonly seen in children. It is followed by an immune-clearance or immune-reactive phase in which the immune system recognises and starts to clear the virus. ALT levels are typically elevated or fluctuating, and there is a higher risk of liver fibrosis. This tends to be the initial phase in people infected with HBV as adults. It lasts from weeks to years and ends with HBeAg seroconversion.
With the loss of HBeAg the person may enter an immune-control phase with very low or undetectable HBV DNA levels, normal ALT and minimal fibrosis progression. However, some people may experience rising HBV DNA levels despite HBeAg negativity. This is caused by virions that do not express HBeAg because of genetic mutations. This immune-escape phase can lead to active necroinflammation and progression of fibrosis.
Figure 1. Natural history of chronic HBV infection
Substantial progress has been made in the treatment of chronic hepatitis B in the past decade but the appropriate time for starting treatment remains a topic of debate. Although currently available treatment is effective in suppressing HBV replication, it fails to eradicate the virus necessitating long treatment duration and perhaps lifelong treatment. 作者: StephenW 时间: 2013-6-26 22:04
Treatment sequence in adults with HBeAg-positive chronic hepatitis B and compensated liver disease
Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-positive chronic hepatitis B and compensated liver disease[1].
Offer tenofovir disoproxil as second-line treatment to people who do not undergo HBeAg seroconversion or who relapse (revert to being HBeAg positive following seroconversion) after first-line treatment with peginterferon alfa-2a.
Offer entecavir as an alternative second-line treatment to people who cannot tolerate tenofovir disoproxil or if it is contraindicated.
治疗成人HBeAg阳性慢性乙型肝炎,代偿期肝病序列
Treatment sequence in adults with HBeAg-negative chronic hepatitis B and compensated liver disease
Offer a 48-week course of peginterferon alfa-2a as first-line treatment in adults with HBeAg-negative chronic hepatitis B and compensated liver disease[1].
Offer entecavir or tenofovir disoproxil as second-line treatment to people with detectable HBV DNA after first-line treatment with peginterferon alfa-2a.
Offer tenofovir disoproxil to women with HBV DNA greater than 107 IU/ml in the third trimester to reduce the risk of transmission of HBV to the baby[2].